Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma.

BACKGROUND: Laparoscopic adrenalectomy for pheochromocytoma remains subject of
debate, owing to the systemic consequences of pneumoperitoneum in patients with
catecholamine-secreting tumors.
METHODS: A prospective randomized study was conducted (2000-2006), evaluating
cardiovascular instability during open (n = 9, group A) or laparoscopic (n = 13,
group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were
recorded by invasive monitoring.
RESULTS: Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients
(group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient (p = n.s.).
Blood loss (164 +/- 94 cc versus 48 +/- 36 cc, p < 0.05) and operative time (180
+/- 40 versus 158 +/- 45 min, p = n.s.) favored laparoscopic procedures.
Postoperative morbidity and mortality were nil. Hospital stay was shorter in
group B (p < 0.05). Long-term follow-up was always normal.
CONCLUSIONS: Laparoscopic approach for pheochromocytoma can be as safe as open
surgery; intraoperative haemodynamic instability, although usually controlled
with success, remains a source of concern.